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Alex Mitchell www.psycho-oncology.infoLorraine GraingerElena Baker-GlennKaren Lord
Department of Cancer & Molecular Medicine, Leicester Royal Infirmary
IPOS 2010, Quebec CityIPOS 2010, Quebec City
T275 - A Large Scale Pragmatic Validation of the HADS for Major Depression in an Ethnically Diverse Cancer PopulationT275 - A Large Scale Pragmatic Validation of the HADS for Major
Depression in an Ethnically Diverse Cancer Population
1. Background1. Background
What methods are used to detect mood disorders?
How often do clinicians look for mood complications?
Methods to Evaluate Depression
Conventional Scales
Short (5-10) Long (10+)
1,2 or 3 Simple QQ15%
Clinical Skills Alone73%
ICD10/DSMIV0%
Short QQ3%
Other/Uncertain9% Other/Uncertain
2%
Use a QQ15%
ICD10/DSMIV13%
Clinical Skills Alone55%
1,2 or 3 Simple QQ15%
Cancer StaffCurrent Method (n=226)
Psychiatrists
Comment: Current preferred method of eliciting symptoms of distress/depression
0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
1
0 0.1 0.2 0.3 0.4 0.5 0.6 0.7 0.8 0.9 1
Pre-test Probability
Pos
t-tes
t Pro
babi
lity
Baseline Probability
Depression+
Depression-
Comment: Slide illustrates Bayesian curve – pre-test post test probability for every possible prevalence
2. HADS – Primary Analysis +Meta-Analysis2. HADS – Primary Analysis +Meta-Analysis
We analysed data collected from Leicester Cancer Centre from 2007-2009 involving approximately 1000 people approached by a research nurse, research physician and two therapeutic radiographers.
The researcher applied DSMIV criteria of major depressive disorder (MDD).
We collated full data on 690 patient assessments of whom 12.9% had MDD, 121 were palliative and 115 (16.7%) were from ethnic minorities (largely British South Asian of India descent).
Graphical – Screening principles
Non-Depressed
Depressed
# ofIndividuals
Cut-Off
# ofIndividuals
Severity of Depression
HighLow
High Sensitivity >>>>
<<<< low Specificity
ResultsResults
In the parent sample of 690, the sensitivity and specificity were as follows
Sensitivity Specificity
HADS-A 87.6% 72.3%
HADS-D 86.5% 80.1%
HADS-T 95.5% 76.3%.
The AUC was highest for HADS-T > HADS-D > HADS-A.
HADS-A = 0.865506 (cut9)HADS-D = 0.900949 (cut7)
HADS-T = 0.916096 (cut15)
~Ethnic Minority~Ethnic Minority
30% in urban areas – largley british south asian(india)
20% in county
15% in hospital care
Ethnic MinoritiesEthnic Minorities
Sensitivity and specificity were as follows
HADS-A 93.1% 66.3%
HADS-D 86.2% 65.1%
HADS-T 96.6% 66.3%.
HADS-A = 0.846231 (cut9)HADS-D = 0.796512 (cut7)HADS-T = = 0.84603 (cut15)
ConclusionsConclusions
In the mixed populations the HADS-D was preferred
In the ethnic minority population and HADS-A or HADS-T were preferred
There was no difference by cancer stage.